Provider Demographics
NPI:1881380616
Name:MITCHELL'S PHARMACY
Entity type:Organization
Organization Name:MITCHELL'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-259-7466
Mailing Address - Street 1:12137 HWY 4
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:CA
Mailing Address - Zip Code:71226
Mailing Address - Country:US
Mailing Address - Phone:318-259-7466
Mailing Address - Fax:318-259-8019
Practice Address - Street 1:12137 HWY 4
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:CA
Practice Address - Zip Code:71226
Practice Address - Country:US
Practice Address - Phone:318-259-7466
Practice Address - Fax:318-259-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy